Patients with non-cancer back or neck pain who use vs do not use tobacco may be more likely to be concurrently prescribed opioid analgesics with muscle relaxants and/or benzodiazepines, according to a study published in The American Journal on Addiction.

Investigators analyzed data from a cross-sectional survey conducted between 2006 and 2009 of visits to office-based outpatient physicians, which included 114,199,536 weighted visits from adult patients presenting with non-cancer neck and back pain. During the survey period, the annual rates of prescription or co-prescription were muscle relaxants, 9.9%; benzodiazepines, 2.5%; opioid analgesics, 20.6%; muscle relaxants plus benzodiazepines, 0.5%; muscle relaxants plus opioid analgesics, 9.1%; benzodiazepines plus opioid analgesics, 3.6%; muscle relaxants plus opioid analgesics plus benzodiazepines, 1.3%; none of the three drugs, 52.6%. Tobacco users accounted for 25.7% of visits for non-cancer pain. Of these, 25.6% were prescribed opioid analgesics and 14.7% were prescribed muscle relaxants plus opioid analgesics.

In non-tobacco users, 17.6% were prescribed opioid analgesics and 10.4% were prescribed muscle relaxants. After adjusting for confounding factors (eg, sex, age depression, and payment source), tobacco users vs non-users were found to be prescribed opioid analgesics (odds ratio [OR], 2.14), muscle relaxants plus opioid analgesics (OR, 2.57), opioid analgesics plus benzodiazepines (OR, 3.66), and a combination of the three drugs (OR, 7.02).

Study limitations include the lack of information regarding the efficacy and appropriateness of prescriptions.

“Tobacco users were significantly prescribed or co-prescribed [opioid analgesics with muscle relaxants and/or benzodiazepines] to a greater extent than non-users….” [P]hysicians and healthcare professionals need to understand the risk of co-prescription for tobacco users… to provide comprehensive pain management strategies involving pharmacological and non-pharmacological approaches.”

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Takaki H, Ieiri I, et al. The association of tobacco use with prescription of muscle relaxants, benzodiazepines, and opioid analgesics for non-cancer pain [published online January 9, 2019]. Am J Addict. doi:10.1111/ajad.12830